Optimal Medical Therapy Prescribing Patterns and Disparities Identified in Patients with Acute Coronary Syndromes at an Academic Medical Center in an Area with High Coronary Heart Disease-Related Mortality

  • Ashley N. FoxEmail author
  • Grant H. Skrepnek
  • Jamie L. Miller
  • Nicholas C. Schwier
  • Toni L. Ripley
Original Research Article



Coronary heart disease (CHD)-related mortality is high in the southern United States. A five-drug pharmacotherapy regimen for acute coronary syndromes (ACS), defined as optimal medical therapy (OMT), can decrease CHD-related mortality. Studies have indicated that OMT is prescribed 50–60% of the time. Assessment of prescribing could provide insight into the potential etiology of disparate mortality.


The aim was to evaluate prescribing of OMT at discharge in patients presenting with an ACS event at an academic medical center and identify patients at risk of not receiving OMT.


A single-center, retrospective cohort of patients with ACS diagnosis between July 2013 and July 2015 was investigated, and a multivariable regression analysis conducted to identify populations at risk of not receiving OMT.


A total of 864 patients were identified by International Classification of Diseases, Ninth Revision (ICD-9) codes, with 533 excluded and 331 analyzed. OMT was prescribed in 69.79%. Patients ≥ 75 years of age [p = 0.003; odds ratio (OR) 0.30; 95% confidence interval (CI) 0.136–0.673], unstable angina presentation (p = 0.042; OR 0.55; 95% CI 0.307–0.977), and surgical management (p = 0.001; OR 0.22; 95% CI 0.095–0.519) were less likely to receive OMT.


The percentage of patients prescribed OMT exceeded the reported global percentage of prescribed OMT. However, disparities exist among specific populations.



We would like to acknowledge Chelsea LaPreze, Pharm.D., for her contributions to data collection for this project.

Compliance with Ethical Standards

Conflict of interest

Authors Fox, Miller, Skrepnek, Schwier, and Ripley declare they have no potential conflicts of interest that might be relevant to the contents of this manuscript.


No external funding was used in the preparation of this manuscript. None of the authors received grant support or other types of extramural funding for the writing of this manuscript.


  1. 1.
    Benjamin EJ, Virani SS, Callaway CW, et al. Heart disease and stroke statistics—2018 update: a report from the American Heart Association. Circulation. 2018;137:e67–492.CrossRefGoogle Scholar
  2. 2.
    Ford ES, Ajani UA, Croft JB, et al. Explaining the decrease in U.S. deaths from coronary disease, 1980–2000. N Engl J Med. 2007;356:2388–98.CrossRefGoogle Scholar
  3. 3.
    Gillum RF, Mehari A, Curry B, Obisesan TO. Racial and geographic variation in coronary heart disease mortality trends. BMC Public Health. 2012;12:410.CrossRefGoogle Scholar
  4. 4.
    Pereira M, Araujo C, Dias P, et al. Age and sex inequalities in the prescription of evidence-based pharmacological therapy following an acute coronary syndrome in Portugal: the EURHOBOP study. Eur J Prev Cardiol. 2014;21:1401–8.CrossRefGoogle Scholar
  5. 5.
    Sheikh-Taha M, Hijazi Z. Evaluation of proper prescribing of cardiac medications at hospital discharge for patients with acute coronary syndromes (ACS) in two Lebanese hospitals. SpringerPlus. 2014;3:159.CrossRefGoogle Scholar
  6. 6.
    Yan AT, Yan RT, Tan M, et al. Optimal medical therapy at discharge in patients with acute coronary sydromes: temporal changes, characteristics, and 1-year outcome. Am Heart J. 2007;154:1108–15.CrossRefGoogle Scholar
  7. 7.
    Yusuf S, Sleight P, Pogue J, et al. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med. 2000;342(3):145–53.CrossRefGoogle Scholar
  8. 8.
    Skrepnek GH. Regression methods in the empirical analysis of health care data. J Manag Care Pharm. 2005;11(3):240–51.PubMedGoogle Scholar
  9. 9.
    Skrepnek GH, Olvey EL, Sahai A. Econometric approaches in evaluating cost and utilization within pharmacoeconomic analyses. Pharm Policy Law. 2012;14(1):105–22.Google Scholar
  10. 10.
    Amsterdam EA, Wenger NK, Brindis RB, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report from the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;130(25):2354–94.CrossRefGoogle Scholar
  11. 11.
    O’Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;61:e78–140.CrossRefGoogle Scholar
  12. 12.
    Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129:S1–45.CrossRefGoogle Scholar
  13. 13.
    Cannon CP, Braunwald E, McCabe CH, et al. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med. 2004;350(15):1495–504.CrossRefGoogle Scholar
  14. 14.
    Heidenreich PA, Lewis WR, Labresh KA, Schwamm LH, Fonarow GC. Hospital performance recognition with the Get with the Guidelines program and mortality for acute myocardial infarction and heart failure. Am Heart J. 2009;158(4):546–53.CrossRefGoogle Scholar
  15. 15.
    Basoor A, Doshi NC, Cotant JF, et al. Decreased readmissions and improved quality of care with the use of an inexpensive checklist in heart failure. Congest Heart Fail. 2013;19(4):200–6.CrossRefGoogle Scholar
  16. 16.
    Wai A, Pulver L, Oliver K, Thompson A. Current discharge management of acute coronary syndromes: baseline results from a national quality improvement initiative. Intern Med J. 2012;42:e53–9.CrossRefGoogle Scholar
  17. 17.
    Bi Y, Gao R, Patel A, et al. Evidence-based medication use among Chinese patients with acute coronary syndromes at the time of hospital discharge and 1 year after hospitalization: results from the Clinical Pathways for Acute Coronary Syndromes in China (CPACS) study. Am Heart J. 2009;157:509–16.CrossRefGoogle Scholar
  18. 18.
    Al-Zakwani I, Zubaid M, Panduranga P, et al. Medication use pattern and predictors for optimal therapy at discharge in 8176 patients with acute coronary syndromes from 6 Middle Eastern countries: data from the gulf registry of acute coronary events. Angiology. 2011;62(6):447–54.CrossRefGoogle Scholar
  19. 19.
    Pfeffer MA, Braunwald E, Moye LA, The SAVE Investigators, et al. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the survival and ventricular enlargement trial. N Engl J Med. 1992;327(10):669–77.CrossRefGoogle Scholar
  20. 20.
    Davis AM, Vinci LM, Okwuosa TM, Chase AR, Huang ES. Cardiovascular health disparities: a systematic review of health care interventions. MCRR. 2007;64:29s–100s.PubMedGoogle Scholar
  21. 21.
    Scirica BM, Cannon CP, Antman EM, et al. Validation of the thrombolysis in myocardial infarction (TIMI) risk score for unstable angina pectoris and non-ST-elevation myocardial infarction in the TIMI III registry. Am J Cardiol. 2002;90(3):303–5.CrossRefGoogle Scholar
  22. 22.
    Hwang IC, Jeon JY, Kim Y, et al. Association between aspirin therapy and clinical outcomes in patients with non-obstructive coronary artery disease: a cohort study. PLoS One. 2015;10(6):e0129584.CrossRefGoogle Scholar
  23. 23.
    Hwang IC, Jeon JY, Kim Y, et al. Statin therapy is associated with lower all-cause mortality in patients with non-obstructive coronary artery disease. Atherosclerosis. 2015;239(2):335–42.CrossRefGoogle Scholar
  24. 24.
    Tam LM, Fonarow GC, Bhatt DL, et al. Achievement of guideline-concordant care and in-hospital outcomes in patients with coronary artery disease in teaching and nonteaching hospitals: results from get with the guidelines—coronary artery disease program. Circ Cardiovasc Qual Outcomes. 2013;6(1):58–65.CrossRefGoogle Scholar
  25. 25.
    Faridi KF, Peterson ED, McCoy LA, et al. Timing of first postdischarge follow-up and medication adherence after acute myocardial infarction. JAMA Cardiol. 2016;1(2):147–55.CrossRefGoogle Scholar
  26. 26.
    Lauffenburger JC, Robinson JG, Oramasionwu C, Fang G. Racial/ethnic and gender gaps in the use of and adherence to evidence-based preventative therapies among elderly Medicare Part D beneficiaries after acute myocardial infarction. Cirrculation. 2014;129(7):754–63.CrossRefGoogle Scholar
  27. 27.
    Rassi AN, Cavender MA, Fonarow GC, et al. Temporal trends and predictors in the use of aldosterone antagonists post-acute myocardial infarction. J Am Coll Cardiol. 2013;61(1):35–40.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Department of Pharmacy: Clinical and Administrative SciencesThe University of Oklahoma College of PharmacyOklahoma CityUSA
  2. 2.Department of Pharmacy: Clinical and Administrative SciencesThe University of Oklahoma College of PharmacyOklahoma CityUSA
  3. 3.Department of Pharmacy: Clinical and Administrative SciencesThe University of Oklahoma College of PharmacyOklahoma CityUSA
  4. 4.Department of Pharmacy: Clinical and Administrative SciencesThe University of Oklahoma College of PharmacyOklahoma CityUSA
  5. 5.TRC Healthcare, Pharmacist’s LetterOklahoma CityUSA

Personalised recommendations